People often ask questions that are indicative of how they believe Rich is functioning. “He is still driving?” some ask with an incredulous tone in their voice. “How can he still drive?”
The ability to drive safely is a product of several different functions working together: Intelligence; coordination; visual and spacial awareness; interpretation of auditory cues, and; memory. Each of these areas may be impacted by age, medication and/or drugs/alcohol, physical limitations and a person’s emotional state. Picture a 35-year-old guy who recently had shoulder surgery, took a pain pill 3 hours ago, drank one beer and gets in a car after a fight with is wife. Would you think his driving might be impaired? Slightly? Significantly? It would depend on other factors, as well. Is the guy a good driver in the first place? Does he have really good hand/eye coordination or is he basically a klutz? Is his knowledge of traffic laws marginal or excellent? Is he driving in a rural area or in crowded, noisy, chaotic traffic conditions? What are the weather, road and lighting conditions? How angry is he and what are his abilities to focus on the task at hand — driving — and not the argument with his wife? His impairment of physical functioning is definitely a consideration and either enhanced or mitigated by all the other factors.
Frontotemporal Degeneration is characterized by the deterioration of the brain. It begins in different areas and from what I find in my research, often is a somewhat unique presentation in each patient. There are similarities in FTD’ers who have degeneration in certain parts of their brains, but that still does not mean they will have the same exact symptoms. Rich’s FTD seems to have begun in his frontal lobes which, simplistically stated, are responsible for emotional expression, control and stability. Rich still maintains excellent hand/eye coordination, motor skills, visual acuity, the ability to respond appropriately to unusual and emergent cues (an ambulance approaching rapidly from a side street, for example) and memory for traffic laws. In experienced drivers, the memory for traffic laws is stored in long term memory, which is often left intact in dementia patients for a … well… very long time.
Rich still does an excellent job of driving our fifth wheel trailer. His spacial orientation is fantastic as well as his ability to access the traffic, road conditions and trailer handling. His memory for traffic laws is intact. The thing I keep an eye on these days is his emotional state. He was having a really bad emotional day a few weeks ago and when he began to pull the fifth wheel out of the side yard he became really frustrated. In “normal” conditions he would have simply backed up and started over, but he got really upset. He stopped and said, “I can’t do this today.” He walked into the garage and straddled the Harley he calls “Bad Ass” (yes, I see the irony in that) and stared at the wall. I called a friend, Steve, who came right over and moved the fifth wheel for us. When Steve and I walked into the garage, Rich was sitting on Bad Ass sobbing. Steve wrapped Rich in his arms and held him. I was so touched by Steve’s gentle, loving gesture that I started crying. Steve’s eyes teared up as he held Rich for several minutes. In the silence, Steve’s compassion spoke volumes — one man to another.
I know the day will come that Rich can no longer drive the truck pulling the fifth wheel, cars or the motorcycles. I am hyper alert for all the safety issues and WILL NOT hesitate to do what I have to do. That does not mean it will be easy. My dad did a slow decline into Alzheimer’s and my mom and I had to take his drivers license away. My mom had to tell him why he couldn’t drive ten times a day because he could not remember that he could not drive. I told her she needed a little sign to hold up that said, “The doctor said you can no longer drive because of all the little strokes you have had that have hurt your brain.” (If you told him he had Alzheimer’s, he would get really upset.)
If you are struggling with the decision regarding a loved one’s driving abilities, this article has some excellent information that will help you access the situation:
I particularly liked the table that helps evaluate the levels of dementia and the table that helps evaluate the risk factors involved in driving. If you are hesitant about taking away a loved one’s driving privileges, whether from FTD, physical/emotional impairments, dementia or simply old-age, these tables can help cut through the dangerous emotion of denial. If it is needed and you cannot do it, or the person will not cooperate with you, speak to your doctor. The doctor knows how to notify the DMV and hopefully can help the patient understand. Hopefully, that understanding will “stick.” If not, get your little “sign” ready to hold up every time they hound you to let them drive.
So now when people ask how Rich can still drive, I can refer them to this blog post. I have found that it is exhausting explaining all the nuances of living with FTD to people. Unless you live with it… or have the damn disease … it is FAR MORE than mere words can express. I will continue to try.